First step is to evaluate the contractility of the uterus.
Initial management is a firm massage of the uterine fundus, expression of any clots in the uterus, and eliminating bladder distension.
Continuous IV infusion of 10- 40 units of oxytocin in 1000 ml of Ringer's lactate or normal saline solution to contract uterus and decrease bleeding.
If the uterus fails to respond to oxytocin, a dose of 0.2 mg ergonovine (Ergotrate) or methylergonovine (Methergine) may be given IM to produce sustained uterine contractions.
It is more common to administer 0.25 mg dose of derivative of prostaglandin F2 alpha (carboprost tromethamine) IM to help the uterus contract.
Oral 400-800 mg and rectal 1000 mg misoprostol has also been administered.
Recombinant factot VIIa may also be useful in managing PPH.
Restore circulating blood volume and eliminate the cause of hemorrhage
To restore circulating blood volume, a rapid IV infusion of crystalloid solution is given at a rate of 3 ml infused every 1 ml of estimated blood lostt.
Pack red blood cells are usually infused if the woman is still actively bleeding and no improvement in her condition is noted after the initial crystalloid infusion.
Infusion of fresh frozen plasma may be needed if clotting factors and platelet counts are below normal values.
Provide discharge planning instructions:
Woman may feel fatigue and exhaustion because of blood loss.
Limit activities to conserve strength.
Increase dietary iron and protein intake, iron supplements may be ordered.
Observe for delayed or insufficient lactation and postpartum depression.
Refer to home care or to community resources.
Perry, S., Hockenberry, M., Lowdermilk, D., & Wilson, D. (2010). Maternal child nursing care. (4 ed., pp. 576-579). Maryland Heights, MO: Mosby Elsevier.
Medical Management Including Pharmacology
- First step is to evaluate the contractility of the uterus.
- Initial management is a firm massage of the uterine fundus, expression of any clots in the uterus, and eliminating bladder distension.
- Continuous IV infusion of 10- 40 units of oxytocin in 1000 ml of Ringer's lactate or normal saline solution to contract uterus and decrease bleeding.
- If the uterus fails to respond to oxytocin, a dose of 0.2 mg ergonovine (Ergotrate) or methylergonovine (Methergine) may be given IM to produce sustained uterine contractions.
- It is more common to administer 0.25 mg dose of derivative of prostaglandin F2 alpha (carboprost tromethamine) IM to help the uterus contract.
- Oral 400-800 mg and rectal 1000 mg misoprostol has also been administered.
- Recombinant factot VIIa may also be useful in managing PPH.
- Restore circulating blood volume and eliminate the cause of hemorrhage
- To restore circulating blood volume, a rapid IV infusion of crystalloid solution is given at a rate of 3 ml infused every 1 ml of estimated blood lostt.
- Pack red blood cells are usually infused if the woman is still actively bleeding and no improvement in her condition is noted after the initial crystalloid infusion.
- Infusion of fresh frozen plasma may be needed if clotting factors and platelet counts are below normal values.
- Provide discharge planning instructions:
- Woman may feel fatigue and exhaustion because of blood loss.
- Limit activities to conserve strength.
- Increase dietary iron and protein intake, iron supplements may be ordered.
- Observe for delayed or insufficient lactation and postpartum depression.
- Refer to home care or to community resources.
Perry, S., Hockenberry, M., Lowdermilk, D., & Wilson, D. (2010). Maternal child nursing care. (4 ed., pp. 576-579). Maryland Heights, MO: Mosby Elsevier.